Voyager Gold 500 - 60597ID0350010 Health Insurance Plan

PacificSource Health Plans health insurance plan with the Plan ID 60597ID0350010. The plan is called Voyager Gold 500.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 81.61% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.39% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 60597ID0350010
Health Insurance Plan Year 2024
State Idaho
Health Insurance Issuer PacificSource Health Plans
Health Insurance Plan Variant 60597ID0350010-01
Provider Network(s) ['IDN005']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Dec 2024 06:12 GMT).

Providers Idaho All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard On Exchange Plan - 60597ID0350010-01

Open to Indians below 300% FPL - 60597ID0350010-02

Open to Indians above 300% FPL - 60597ID0350010-03

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 17 Dec 2024 06:12 GMT

Voyager Gold 500 Health Insurance Plan Variant 60597ID0350010-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.816087463
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold On Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family per person not applicable | per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 30.00%
Drug EHB Deductible, In Network (Tier 1), Family $0 per person | $0 per group
Drug EHB Deductible, In Network (Tier 1), Individual $0
Drug EHB Deductible, Out of Network, Family $10000 per person | $20000 per group
Drug EHB Deductible, Out of Network, Individual $10,000
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Pregnancy, Diabetes, Heart Disease, Asthma
EHB Percent of Total Premium 100%
First Tier Utilization 100%
Formulary ID IDF018
HIOS Product ID 60597ID035
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 60597
Market Coverage Individual
Medical Drug Deductibles Integrated No
Medical Drug Maximum Out of Pocket Integrated Yes
Medical EHB Deductible, Combined In/Out of Network, Family per person not applicable | per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 30.00%
Medical EHB Deductible, In Network (Tier 1), Family $500 per person | $1000 per group
Medical EHB Deductible, In Network (Tier 1), Individual $500
Medical EHB Deductible, Out of Network, Family $10000 per person | $20000 per group
Medical EHB Deductible, Out of Network, Individual $10,000
Metal Level Gold
Multiple In Network Tiers No
National Network Yes
Network ID IDN005
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Care Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Care Only
Plan Effective Date 1/1/2024
Plan ID (Standard Component ID with Variant) 60597ID0350010-01
Plan Marketing Name Voyager Gold 500
Plan Type PPO
Plan Variant Marketing Name Voyager Gold 500
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $3,600
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $1,100
SBC Scenario, Having Diabetes, Copayment $400
SBC Scenario, Having Diabetes, Deductible $500
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $600
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID IDS006
Source Name SERFF
Plan ID 60597ID0350010
State Code ID
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family per person not applicable | per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $8500 per person | $17000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family $85500 per person | $171000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $85,500
Unique Plan Design No
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of Voyager Gold 500 Health Insurance Plan, 60597ID0350010

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Voyager Gold 500, 60597ID0350010 Health Insurance Plan, 60597ID0350010

  • Does Voyager Gold 500 Health Insurance Plan, 60597ID0350010 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (60597ID0350010) Health Insurance Plan, Variant (60597ID0350010-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, Diabetes, Heart Disease, Asthma

    Does (60597ID0350010) Health Insurance Plan, Variant (60597ID0350010-01) have Out Of Country Coverage?

    Yes. Details: Emergency Care Only

    Does (60597ID0350010) Health Insurance Plan, Variant (60597ID0350010-01) have Out of Service Area Coverage?

    Yes. Details: Emergency Care Only

    Does (60597ID0350010) Health Insurance Plan, Variant (60597ID0350010-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, Diabetes, Heart Disease, Asthma

    Does Voyager Gold 500 Health Insurance Plan, Variant (60597ID0350010-01) offer Disease Management Programs for Asthma?

    Yes, the Voyager Gold 500 Health Insurance Plan Variant 60597ID0350010-01 offers Disease Management Program for Asthma.

    Does Voyager Gold 500 Health Insurance Plan, Variant (60597ID0350010-01) offer Disease Management Programs for Heart disease?

    Yes, the Voyager Gold 500 Health Insurance Plan Variant 60597ID0350010-01 offers Disease Management Program for Heart disease.

    Does Voyager Gold 500 Health Insurance Plan, Variant (60597ID0350010-01) offer Disease Management Programs for Diabetes?

    Yes, the Voyager Gold 500 Health Insurance Plan Variant 60597ID0350010-01 offers Disease Management Program for Diabetes.

    Does Voyager Gold 500 Health Insurance Plan, Variant (60597ID0350010-01) offer Disease Management Programs for Pregnancy?

    Yes, the Voyager Gold 500 Health Insurance Plan Variant 60597ID0350010-01 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 17 Dec 2024 06:12 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API